Healthcare Provider Details

I. General information

NPI: 1659287464
Provider Name (Legal Business Name): MANNA ASSISTED LIVING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

791 N LISBON DR
CHANDLER AZ
85226-2380
US

IV. Provider business mailing address

791 N LISBON DR
CHANDLER AZ
85226-2380
US

V. Phone/Fax

Practice location:
  • Phone: 480-247-6810
  • Fax:
Mailing address:
  • Phone: 480-247-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TERESITA PRYOR
Title or Position: MANAGER/OWNER
Credential:
Phone: 602-813-3408